gcada 21st annual summit
TRANSCRIPT
GCADA 21st Annual Summit
Teenage Addiction: A Pain in the Brain
Dr. Randie O’Neil, LCADC, SAC
September 15, 2012 Hyatt Regency
New Brunswick
Objectives
Review Prevention Programs in the School
Understand adolescents and brain function
Overview of addiction and adolescents
Explain why treatment doesn’t always work the
first time around
Explore myths of addiction and the biological
origins
Guidance Vs Counselor
The counseling profession entered the
schoolhouse in the early 20th century
Jesse B. Davis - introduced “vocational and
moral guidance” as a curriculum into an English
course
This was the first systematic guidance program
in public schools
Safe and Drug Free School
1986 Federal Government Determines
that substance use is an hindrance to
academic achievement.
Schools need to develop programs to
ensure student academic success
New Jersey Responds
NJS 18A:40A
Establish comprehensive alcohol, tobacco and
other drug abuse programs.
Adoption of policies and procedures for the
intervention of student substance abuse
Reporting, notification and examination
procedures for students suspected of
substance abuse.
18A:40A Continued
Any staff member that suspects a
student is under the influence report the
matter the incident and student must be
evaluated by a medical professional
Staff to receive inservice
Establishes the position of Substance
Awareness Coordinator
Confidentiality
6A:16-3.2
Confidentiality of student alcohol and other
drug information.
Counseling services are confidential in matters
of substance abuse.
Adolescents have a right to counseling
services when parents are is dependant
onsubstances
Require a court order to gain access to
records
CAVEATS
New discoveries—research is still in its infancy
Do NOT over-interpret or interpret too simplistically
Most research has been conducted on animals—we assume the information transfers to people
Behavior is the result of complex interactions among individual, environment, genetics, situation, cultural expectations, and numerous other factors
BRAIN FACTS
Brain weighs
approximately 3 pounds
Brain has approximately
100 billion neurons and
1 trillion supporting cells
Neurons grow and
organize themselves
into efficient systems
that operate a lifetime
Brain controls ALL
activities
Emotion and cognition
are intertwined
Neurons can re-route
circuits
Brain and environment
involved in delicate duet
Brain never stops
adapting and changing
BRAIN STRUCTURES
Frontal Lobe
Parietal Lobe
Temporal Lobe
Occipital Lobe
Cerebellum
Corpus Callosum
Brain Stem
BRAIN STRUCTURES
Brain is an organ of behavior—both overt
behavior and consciousness are
manifestations of the work of the brain
Different regions of the brain regulate different
functions. Our thoughts, behaviors, and
emotions are the result of how the different
parts of the brain work together to process
information and memories
FRONTAL LOBE
Seat of personality, judgment, reasoning, problem solving, and rational decision making
Provides for logic and understanding of consequences
Governs impulsivity, aggression, ability to organize thoughts, and plan for the future
Controls capacity for abstraction, attention, cognitive flexibility, and goal persistence
Undergoes significant changes during adolescence — not fully developed until mid 20’s
FRONTAL LOBE
As the “prefrontal cortex” area of the frontal lobe matures, through experience and practice, teens can reason better, develop more impulse control, and make better judgments
Prefrontal cortex is one of the last areas of the brain to fully develop
Increased need for struc-
ture, mentoring, guidance
TEMPORAL LOBES
Responsible for hearing, understanding
speech, and forming an integrated sense of
self
Responsible for sorting new information and
for short term memory
Contains the limbic-reward system (amygdala,
hippocampus, nucleus acumbens, and vta)
Matures around ages 18-19
TEMPORAL LOBE/LIMBIC
SYSTEM
Limbic system regulates emotions and
motivations—particularly those related to
survival—such as fear, anger, and pleasure
(sex and eating)
Feelings of pleasure/reward are very powerful
and self-sustaining. Pleasurable behaviors
activate a circuit of specialized nerve cells in
the limbic area that is devoted to producing
and regulating pleasure called the reward
system
REWARD SYSTEM
Drugs of abuse activate the reward system in
the limbic area of the brain—producing
powerful feelings of pleasure
Desire to repeat drug using behavior is strong
Drugs of abuse can/do exert powerful control
over behavior because they act directly on the
more primitive, survival limbic structures—
over-ride the frontal cortex in controlling our
behavior
Brain Circuitry
NEURON —specialized cell designed to transmit information to other nerve cells and muscles
Each neuron consists of a cell body, axon, and dendrite
Axon– an electricity conducting fiber that carries information away from the cell body
Dendrite– receives messages from other neurons
Synapse– contact point where one neuron “communicates” with another neuron
BRAIN CIRCUITRY
Neurons “communicate” by transmitting electrical impulses along their axons
Axons send messages across a synapse to the receiving dendrite of the target neuron
Each neuron has an average of 6,000 dendrite receptors
Dendrite receptor sites are specialized areas— “lock and key”
BRAIN CIRCUITRY
A neuron may receive many different
messages at the same time (Prioritize)
Each neuron has to “interpret” incoming
messages
Neuronal communication is currently
under intense study because it plays
such a critical role in health and well
being
BRAIN CIRCUITRY
Gray matter contains neurons that are responsible for “thinking” (100 billion)
White matter contains suportive cells with nutritive roles (dendrites—1 trillion)
Myelin is a layer of insulation that progressively insulates these supportive cells and is whitish in color
Myelin makes white matter more efficient—just like insulation on electric wires—contributes to overall cognitive functioning
BRAIN CIRCUITRY
Example—It is the gray matter that recognizes the soccer ball coming towards you; it is the white matter that orders the movement of your leg to kick the ball
Myelin allows for more efficient communication between the white and the gray matter—mylena-
tion continues until
early 30’s
NEUROTRANSMITTERS
All messages all passed to connected
neurons through the form of chemicals
called neurotransmitters
Neurotransmitters are released from the
end of the axon, cross the synapse, and
bind to the specific receptors on the
dendrites of the
targeted neuron
MAJOR
NEUROTRANSMITTERS
Acetylcholine—regulates memory
Dopamine—produces pleasure through the “reward system”; multiple functions including controlling movement, regulates hormonal responses, important to cognition and emotion; abnormalities in dopamine levels have been implicated in schizophrenia
Serotonin—Plays a role in sleep; involved in sensory perception; and involved in controlling emotional states such as anxiety and depression
MAJOR
NEUROTRANSMITTERS
Glutatmate — excites the firing of
neurons, aids process of memory
Gamma-aminobutyric (GABA) — inhibits
the firing of neurons
OVERPRODUCTION AND
PRUNING
Brain development occurs in 2 basic stages– growth spurts/overproduction of neurons and pruning
Critical phases: in utero
0-3 years overproduction
10-13 years
Overproduction results in significant increase in the number of neurons and synapses
Exuberant growth during these 3 phases gives the brain enormous potential
PRUNING
These 3 critical phases are quickly followed by a process in which the brain prunes and organizes its neural pathways
LEARNING is a process of creating and strengthening frequently used synapses (brain discards unused synapses)
Brain keeps only the most efficient and “strong” synapses
Children/teens need to understand that they decide which synapses flourish and which are pruned away
PRUNING
“USE IT OR LOSE IT”– Reading,
sports, music, video games, x-box,
hanging out—whatever a child/teen is
doing—these are the neural synapses
that will be retained
How children/teens spend their time is
CRUCIAL to brain development since
their activities guide the structure of the
brain
ADOLESCENCE
Awkward period between sexual maturational
and the attainment of adult roles and
responsibilities
Begins with the domain of physical/biological
changes related to puberty, but it ends in the
domain of social roles
Encompasses the transition from the status of
a child (one who requires monitoring) to that of
an adult (responsible for behavior)
ADOLESCENCE
Adolescence is much broader and longer than the teenage years alone (has changed significantly over the past 150 years)
Adolescence now stretches across more than a decade, with pubertal onset often beginning by age 9-12 and adult roles delayed until mid twenties (Worthman, 1995))
In 187 societies, the interval between puberty and achieving adult status was typically 2 years for girls and 4 years for boys (Schlegel and Barry, 1991)
ADOLESCENCE
Most elements of cognitive development
show a trajectory that follows age and
experience rather than the timing of
puberty
Research conducted by Martin, 2003,
demonstrates a significant positive
correlation between pubertal maturation
and sensation seeking
ADOLESCENCE
PUBERTY
Romantic motivation
Sexual interest
Emotional intensity
Sleep cycle changes
Appetite
Risk for affective disorders (girls)
Increase in risk taking, sensation seeking, and novelty seeking
AGE/EXPERIENCE
Planning
Logic, reasoning
Inhibitory control
Problem solving
Understanding consequences
Affect regulation
Goal setting and pursuit
Judgment and abstract thinking
ARE ADOLESCENTS MORE
SUSCEPTIBLE TO ALCOHOL
THAN ADULTS?
Adolescent rats are LESS sensitive to
the sedative and motor impairment
effects of alcohol.
Adolescent rats are MORE sensitive to
the social disinhibition induced by
alcohol use
ARE ADOLESCENTS MORE
SUSCEPTIBLE THAN ADULTS TO
ALCOHOL?
Adolescents appear to be MORE
sensitive to the learning and memory
impairment effects of alcohol
Adolescent drunk rats perform worse on
memory tasks than adult drunk rats
Disruption of the Hippocampus
Brain damage in the PFC
Percentage of U.S. Population (Aged 12 and Over)
Who have ever Used Drugs of Abuse
0
10
20
30
40
50
60
70
Tobacco Heroin THC Cocaine Alcohol
ALCOHOL’S EFFECTS
Adolescents with a history of extensive
alcohol use, compared to a control
group…
Reduced Hippocampus volume (10-35%)
Less brain activity during memory tasks
DISPARITIES OF
ADOLESCENCE
Adolescence is a TRANSITIONAL period
during which a child is becoming, but is
not yet, an adult
Adolescent brains are far less developed
than we previously believed
Normal adolescent development
includes conflict, facing insecurities,
creating an identity, mood swings, self-
absorption, etc.
ADOLESCENT BRAIN
DEVELOPMENT
Underdevelopment of the frontal
lobe/prefrontal cortex and the limbic
system make adolescents more prone to
“behave emotionally or with ‘gut’
reactions”
Adolescents tend to use an alternative
part of the brain– the AMYGDALA
(emotions) rather than the prefrontal
cortex (reasoning) to process information
ADOLESCENT BRAIN
DEVELOPMENT
Amygdala and nucleus acumbens (limbic system within the prefrontal cortex) tend to dominate the prefrontal cortex functions– this results in a decrease in reasoned thinking and an increase in impulsiveness
Because of immature brains, adolescents do not handle social pressure, instinctual urges, and other stresses the way adults do
A major part of adolescence is learning how to assess risk and consequences — adolescents are not yet skilled at these tasks
HOT AND COLD COGNITION
Thoughts and emotions are intertwined – teens need to develop a balance between cognitive and affective systems of the brain
“COLD” cognition refers to thinking under conditions of low emotions and/or arousal
“HOT” cognition refers to thinking under conditions of strong feelings or arousal
Decisions made under conditions of strong affect are difficult to influence by cool rational thought alone
HOT AND COLD COGNITION
Decision making in teens cannot be fully
understood without considering the role of
emotions and the interaction between thinking
and feeling
Teen decisions are unlikely to emerge from a
logical evaluation of the risk/benefits of a
situation – rather decisions are the result of a
complex set of competing feelings – desire to
look cool, fear of being rejected, anxiety about
being caught, excitement of risk, etc.
ADOLESCENT BRAIN
DEVELOPMENT
Adolescents are not very skilled at
distinguishing the subtlety of facial expression
(excitement, anger, fear, sadness, etc.)—
results in a lot of miscues—leads to lack of
communication and inappropriate behavior
Differences in processing, organization, and
responding to information/events leads to
misperceptions and misunderstanding verbal
and non-verbal cues
Experimentation
High
Baseline behavior _________________________________________
Infrequent use
Return to baseline behavior
Enjoy use-what feels good must be good
Little tolerance + return to baseline
Normal mood
Regular Use-Seeking the mood High
Baseline behavior _________________________________________
Pain __________________________
Adds hard liquor
Binge drinking
Use during the week
Increased tolerance
Consequences-hangovers-skip school
Drop non drug using friends
Lying, more money
Mood changes
Daily Preoccupation-preoccupied with the
mood swing High
Baseline behavior _________________________________________
Pain __________________________
More dangerous drugs
Drugs becomes central focus
Legal problems
Mood changes/withdrawal
Unable to quit on own
SCARS THAT WON’T HEAL
Growing evidence of altered brain
development and functioning as the
result of abuse and neglect
Our interactions with the world “organize
our brain’s development” and shapes the
person we become (Shore, 1997)
Brain will develop to respond to a
positive or a negative environment
SCARS THAT WON’T HEAL
Chronic stress, abuse, and neglect sensitize certain neural pathways and over-develop certain regions of the brain (limbic region) involved in anxiety and fear. This often results in the under-development of other regions of the brain (frontal lobe)
Chronic stress from fear, violence, abuse, hunger, pain, etc. focuses the brain’s resources on survival and other areas of the brain are not “available” for learning social and cognitive skills
BRAIN’S RESPONSE TO
THREAT
Brain is uniquely designed to mobilize the body in response to threat—all body response—fight or flight
Neurochemical systems cause a cascade of changes in attention, impulse control, sleep patterns, and fine motor control
Chronic activation of the neural
pathways involved in fear creates
“memories” which shape a person’s perception of and response to the environment—indelible perception of the world (attitudinal change?)
NEUROBIOLOGY OF ABUSE
Chronic activation of certain parts of the brain involved in the fear response — hypothalamic-pituitary-adrenal-(HPA) axis
can “wear out” other parts of the brain such as the hippocampus (memory, cognition, communication)
* HPA axis significantly influences cognitive development as well as behavioral and emotional regulation
* Abuse and addiction impact learning, behavior, and psychological and moral development on a cellular level (issue of choice?)
NEUROBIOLOGY OF ABUSE
Neural systems that are chronically activated by threat can change in permanent ways:
-- Altering number of synapses
-- Changing dendritic density
-- Inhibit development of neurons
-- Alter neurotransmitter receptors
-- Change gross structure and volume of the hippocampus
NEUROBIOLOGY OF ABUSE
Chronic stress may have neurotoxic effects
and lead to learning and concentration
impairments secondary to the damage to the
hippocampus including:
-- accelerated loss of neurons (Smythies,
1997)
-- delays in myelination (Dunlop, 1997)
-- abnormalities in developmentally appropriate
pruning (Todd, 1992)
-- inhibition of neurogenesis (Tanapat, 1998)
THE EFFECTS OF ABUSE AND
NEGLECT
Diminished growth in the left hemisphere — may
increase risk for depression (Teicher, 2000)
Irritability in the limbic system can set the stage
for the emergence of panic disorder and post-
traumatic stress disorder (Teicher, 2000)
Smaller growth in the hippocampus can increase
the risk for dissociative disorders and memory
impairment (Teicher, 2000)
ADOLESCENT BRAIN
DEVELOPMENT
To appreciate consequences of risky behavior,
one has to have the ability to think through
potential outcomes and understand the
permanence of consequences, due to an
immature prefrontal cortex, teens are not
skilled at doing this
Teens do not take information, organize it, and
understand it in the same way that adults do—
they have to learn how to do this
ADOLESCENT BRAIN
DEVELOPMENT
Important to understand that teens often
fail to heed common sense or adult
warnings because they simply may not
be able to understand and/or accept
reasons that seem logical and
reasonable to adults
NEVER assume that you and a teen are
having the same understanding of a
conversation
ADOLESCENT BRAIN
DEVELOPMENT
With experience, teens are able to
temper their instinctive ‘gut’ reaction with
more rational, reasoned responses—
they are able to “apply the brakes” to
emotional responses. During this time of
development, teens need adult mentors
and role-models who demonstrate how
to make good decisions and how to
control emotions
ADOLESCENT BRAIN
DEVELOPMENT
Adolescence involves the maturation of
self-regulation of behavior and
emotions—teens need to learn how to
navigate complex social situations under
conditions of strong emotions – such as
social anxieties, romantic relationships,
academic pressures, desires for
immediate gratification vs. long term
goals, moral dilemmas, and
success/failure
PROGRAMMING AND POLICY
ISSUES
Teens are not adults—Brain development is not complete
Teens are operating from the emotional/impulsive/reward oriented part of the brain
Communication is a complicated process
Technology is transforming the world
Disparities between knowing/feeling and understanding/behaving
NEUROSCIENCE OF SKILL
BUILDING
“Skill building is a means of developing
neural network integration and
coordination among various neural
networks” (Cozolino, 2002)
“In order to heal a ‘damaged’ or altered
brain, interventions must activate those
portions of the brain that have been
altered” (Perry, 2000c)
NEUROSCIENCE OF
PREVENTION
We have individuals who, based on life
experiences, have been in effect “hard
wired for negative behaviors”; therefore,
preventionists must ‘re-wire these brains
for positive, successful behavior’ (Shore,
1997)
CORTICAL INTEGRATION
Strengthens the frontal cortex—judgment,
reasoning, rational decision making, problem
solving, etc
Increases the ability of the cortex to process,
inhibit, and organize reflexes, impulses,
information, and emotions
Increases ability to engage thought with affect,
words with emotion, and reason with
unconscious behavior (Seigal,1999)
LIMBIC REGULATION
Limbic system plays a critical role in the
regulation of emotion and memory
“Primed” clients need to re-wire their
brains by learning new skills/options
Clients need to be in a state of “attentive
calm” to learn new cognitive or
behavioral skills/options
Emotions/impulses Logic/reason
ELEMENTS OF EFFECTIVE
PREVNTION INTERACTIONS
SAFETY – provide understanding of persistent fear and hyper vigilance. Help client develop a state of “attentive calm”. Calm client uses cortex and can engage in abstract thinking—anxious client uses limbic system and focuses on non-verbal information and survival.
ROLE PLAYING, MUSIC, IMMEDIATE REWARDS, AND ROLE MODELS – provide corrective experiences, activate several areas of the brain including frontal cortex, and create new memories/options
ELEMENTS OF EFFECTIVE
PREVENTION INTERACTIONS
CORRECTIVE THINKING – correct false assumptions, reframe thinking—client is not bad, stupid, sick, or damaged
STRUCTURE – provide a safe, predictable, consistent environment that helps to reduce anxiety
DISCERNMENT – provide experiences in which clients practice “reading” facial expressions and “social” situations
ELEMENTS OF EFFECTIVE
PREVENTION INTERACTIONS
INFORMATION – help clients understand how
their brains develop; how brain function impacts
behavior; and process for re-wiring the brain
HOT/COLD COGNITION – during stressful,
emotional, or threatening situations “problem
solving” information in the cortex is not easily
accessed; clients need practice and concrete
ways to access information and skills
Defineing the Role of the
Student Assistance Counselor
Prevention should start at home and in
the schools
Defining at risk behavior
Originally at risk for substance
involvement
Included red flag behavior such as change
in behavior, family history, poor grades,
early involvement
Philosophical changes in SAC
program
At risk defined as at risk for academic failure.
Prevention curriculum expansive approaches
SAC involved with broader variety of behaviors
Depression, eating disorders, self injurious
behavior, lack of motivation
Crisis intervention important role for SAC
Adopt new certification criteria 2006
School Resources for Intervention
Intervention and referral services
504 medical modifications
Child Study Team evaluations
PREVENTION
To delay the onset of the use and abuse
of alcohol, tobacco and drugs
Promote healthy relationships between
family, community and peers
Strengthen protective factors and/or to
reduce risk factors
Protective and Risk Factors
Increase a child’s
resiliency in:
Social skills
Family bonds
School attachment
Community
involvement
Vary by age, cultural
identity,
psychosocial
development and
environment
Lack of parental
guidance
School failure
Experiment with
drugs
Prevention Strategies
Universal, all youth
Selective for vulnerable youth
Indicate youths already involved in
substance use
Connecting Services
Children feel competent when and do well in school when:
Students are connected and have access to community resources
Families seek preventions services, value education and spend time with children
Parents have clear expectations
Parents and schools have consistent message
School involve families to encourage positive behavior
Elements of a Good Program
Skilled leader that student appreciate
Students learn to recognize stress
Develop refusal skills
Accurate information about substances
Include peer groups in activities
Use interactive techniques
Involve families and communities
SUMMARY
It appears that aggressive, submissive, and frustration behaviors may be genetically encoded. If relationships are negative, threatening, and/or fear inducing, the lower brain responses become dominant and the cognitive regulating structures do not develop to their full capacity; consequently, an individual may not develop the cognitive ability to control emotions or behavior.
SUMMARY
Prevention specialists need to educate
themselves and their clients about
neurobiology of abuse and addiction as well as
brain development
Interventions must activate those portions of
the brain that have been altered or
underdeveloped
Positive therapeutic experiences can
contribute to healing and growth